Department of Public Health and Primary Care, Cambridge Public Health, University of Cambridge, Cambridge, UK.
Department of Epidemiology and Applied Clinical Research, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK.
Glob Health Res Policy. 2021 Mar 1;6(1):8. doi: 10.1186/s41256-021-00190-7.
Universal health coverage (UHC) embedded within the United Nations Sustainable Development Goals, is defined by the World Health Organization as all individuals having access to required health services, of sufficient quality, without suffering financial hardship. Effective strategies for financing healthcare are critical in achieving this goal yet remain a challenge in Sub-Saharan Africa (SSA). This systematic review aims to determine reported health financing mechanisms in SSA within the published literature and summarize potential learnings.
A systematic review was conducted aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. On 19 to 30 July 2019, MEDLINE, EMBASE, Web of Science, Global Health Database, the Cochrane Library, Scopus and JSTOR were searched for literature published from 2005. Studies describing health financing approaches for UHC in SSA were included. Evidence was synthesised in form of a table and thematic analysis.
Of all records, 39 papers were selected for inclusion. Among the included studies, most studies were conducted in Kenya (n = 7), followed by SSA as a whole (n = 6) and Nigeria (n = 5). More than two thirds of the selected studies reported the importance of equitable national health insurance schemes for UHC. The results indicate that a majority of health care revenue in SSA is from direct out-of-pocket payments. Another common financing mechanism was donor funding, which was reported by most of the studies. The average quality score of all studies was 81.6%, indicating a high appraisal score. The interrater reliability Cohen's kappa score, κ=0.43 (p = 0.002), which showed a moderate level of agreement.
Appropriate health financing strategies that safeguard financial risk protection underpin sustainable health services and the attainment of UHC. It is evident from the review that innovative health financing strategies in SSA are needed. Some limitations of this review include potentially skewed interpretations due to publication bias and a higher frequency of publications included from two countries in SSA. Establishing evidence-based and multi-sectoral strategies tailored to country contexts remains imperative.
联合国可持续发展目标中纳入了全民健康覆盖（UHC），世界卫生组织将其定义为所有个人都能获得所需的高质量卫生服务，而不会遭受经济困难。有效的医疗保健融资策略对于实现这一目标至关重要，但在撒哈拉以南非洲（SSA）仍然是一个挑战。本系统评价旨在确定已发表文献中报道的 SSA 卫生融资机制，并总结潜在的经验教训。
本系统评价符合系统评价和荟萃分析的首选报告项目（PRISMA）报告准则。2019 年 7 月 19 日至 30 日，检索了 MEDLINE、EMBASE、Web of Science、全球卫生数据库、Cochrane 图书馆、Scopus 和 JSTOR，以获取 2005 年以来发表的文献。纳入了描述 SSA 全民健康覆盖卫生融资方法的研究。证据以表格和主题分析的形式综合。
在所有记录中，有 39 篇论文被选入。在所纳入的研究中，肯尼亚（n=7）进行的研究最多，其次是整个 SSA（n=6）和尼日利亚（n=5）。超过三分之二的选定研究报告了公平的国家健康保险计划对 UHC 的重要性。结果表明，SSA 的大多数卫生保健收入来自直接自付费用。另一种常见的融资机制是捐助者供资，大多数研究都报告了这一机制。所有研究的平均质量评分为 81.6%，表明评估得分较高。两位评价者之间的 Cohen's kappa 评分，κ=0.43（p=0.002），表明存在中度一致性。
适当的卫生融资策略可以保护财务风险，为可持续的卫生服务和全民健康覆盖提供保障。从本次审查中可以明显看出，需要在 SSA 采用创新的卫生融资策略。本综述的一些局限性包括由于发表偏倚导致的潜在解释偏差，以及来自 SSA 两个国家的出版物频率较高。根据国家情况制定基于证据的多部门战略仍然至关重要。
